剖宫产术前应用曲马多的临床镇痛效果

PRE-OPERATIVE ADMINISTRATION OF TRAMDOL AS PREEMPTIVE ANALGESIA FOR CAESAREAN SECTION

摘要:

目的：探讨剖宫产术前曲马多的临床效果，摸索曲马多的合适剂量。方法：依麻醉前用药不同，60例择其剖宫产产妇随机分为三组（每组20例），T0组（肌注0．9％NaCl 2ml);T1组（肌注曲马多1．5mg/kg);T2组（肌注曲马多2mg/kg)，均采用联合阻滞麻醉。观察指标（1）术中及术后4h、8h、12h、24h、48h的VAS评分，术中术后应用镇痛药情况。（2）新生儿1分钟、5分钟apgar评分。结果：（1）T2组术中探查和宫缩痛的VAS评分明显低于T0组，P＜0．01；术后4h、8h、12hT1组和T2组的VAS评分明显低于T0组，P＜0．01；术后24h、48hT2组的VAS评分低于T0组，P＜0．05；T1组和T2组的VAS评分各时点均无明显差异。（2）新生儿1分钟、5分钟apgar评分各组间无明显差异。（3）胎儿娩出后T0组有7例、T1组有2例应用氟芬合剂，术后T0组均立即给吗啡2mg硬膜外腔注入，7例术后口服凯扶兰50mg镇痛，T1组8例平均术后4h给吗啡2mg硬膜外腔注入，T2组5例平均术后6h给吗啡2mg硬膜外腔注入。结论：剖宫产术前应用曲马多能起到减轻术中术后疼痛和减少镇痛药用量的目的；推荐产科的安全剂量为1．5mg/kg。

Abstract:

Objective: To evaluate the clinical analgesic effect of pre operative Tramadol in caesarean section (CS) and its optimal dosage. Methods: 60 elective parturients under going CS were evenly divided into 3 groups: T 0 Group (0.9% NaCl 2ml,im), T 1 Group(Tramadol 1.5mg/kg,im) and T 2 Group (Tramadol 2mg/kg,im): All patients went through combined spinal epidural anesthesia(CSEA). Observed parameters: (1) VAS scoring intraoperatively and 4hrs,8hrs,12hrs,24hrs postoperatively, use of other analgesics intraoperatively and post operatively. (2) Neonatal Apgar scoring for 1min and 5min. Results: (1) In T 2 Group the VAS score was significantly lower than that of T 0 Group during surgical exploration and uterine contraction( P <0.01); VAS score at 4hrs,8hrs,12 hrs postoperatively was significantly lower in T 1 Group and T 2 Group compared to that of T 0 Group( P <0.01). In T 2 Group VAS score was lower than that of T 0 Group at 24 hrs ,48 hrs postoperatively( P <0.05); The VAS score of T 1 Group and T 2 Group at all points didn't show significant difference. (2) There was no significant difference between three groups in neonatal Apgar scoring at 1min and 5min.(3) After delivery 7 patients in T 0 Group and 2 Patients in T 1 Group used Innovar. In group T 0 all patients were given morphine 2mg epidurally at the end of operation ,among them 7 patients in ward used ketorolac 50mg for analgesia. In group T 1, 8 patients were given morphine 2mg epidurally at average time of 4hrs. In group T 2, 5 patients were given morphine 2mg epidurally at average time of 6hrs. Conclusions: Tramadol used before the surgical operation can decrease the intraoperative and postoperative pain intensity and can also decrease the postoperative use of analgesics .Recommended safety dose for obstetric patient is 1.5mg/kg.